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Abstract

Aim: Obesity is a prevalent condition associated with a heightened risk of cardiovascular disease. We assessed the association between normal weight, overweight, and obesity defined by body mass index (BMI) and cardiac structure and function in a sample of 4,845 older adults, aged 66-90 years.

Methods: We performed a cross-sectional analysis of ARIC cohort participants during visit 5 (2011-2013), excluding those with prevalent coronary heart disease, heart failure, or prior myocardial infarction, or race other than black or white. The sample was grouped into 3 categories: normal (n=1326, BMI <25 kg/m2), overweight (n=1881, BMI 25-30 kg/m2), and obese (n=1638, BMI ≥30 kg/m2). Cardiac structure and function were assessed by 2D echocardiography by a core lab. Non-parametric trend, χ2 tests, linear, and logistic regression were used for this analysis. A two-sided p-value <0.05 was considered significant.

Results: Participants who were obese were younger, more likely to be black, and had higher rates of diabetes and hypertension than those who were overweight or had a normal BMI (table). Participants with obesity had larger biventricular cavity sizes, higher left ventricular (LV) mass index, more diastolic dysfunction, and more abnormal geometry (concentric/eccentric hypertrophy or concentric remodeling) than those who were overweight or normal (all p <0.0001). After adjustment (table), right ventricular (RV) function was lowest in obese participants, but there was no significant difference observed in LV ejection fraction.

Conclusion: In ARIC, obesity is associated with increased LV remodeling, impaired diastolic function, and decreased RV function even after adjustment for significant covariates. The relationship of these findings to subsequent clinical events and whether they can be mitigated by weight loss or maintenance warrants further study.